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Review of Laparoscopic Adjustable Gastric Banding to Treat Obesity

Stomach Banding Safety

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Review of Laparoscopic Adjustable Gastric Banding to Treat Morbidly Obese

We attempted to compare the safety and efficacy of laparoscopic adjustable gastric banding with vertical-banded gastroplasty and gastric bypass. Morbid obesity presents a serious health issue for Western countries, with a rising incidence and a strong association with increased mortality and serious comorbidities, such as diabetes, hyperlipidemia, and cardiovascular disease. Unfortunately, conservative treatment options have proven ineffective. Surgical interventions, such as vertical-banded gastroplasty (stomach stapling), Roux-en-Y gastric bypass, and, more recently, laparoscopic gastric banding have been developed with the aim of providing a laparoscopically placed device that is safe and effective in generating substantial weight loss.

Method

Electronic databases were systematically searched for references relating to obesity surgery by (1) laparoscopic adjustable gastric banding (LAGB), (2) vertical banded gastroplasty (VBG), and (3) Roux-en-Y gastric bypass (RYGB).

Results

Only 6 studies reported comparative results for laparoscopic gastric banding and other surgical procedures. One study reported comparative results for all 3 surgical procedures, and this study was only of moderate quality. In total, 64 studies were found that reported results for laparoscopic adjustable gastric banding and 57 studies reported results on the comparative procedures. Laparoscopic adjustable gastric banding was associated with a mean short-term mortality rate of approximately 0.05% and an overall median morbidity rate of approximately 11.3%, compared with 0.50% and 23.6% for Roux-en-Y gastric bypass, and 0.31% and 25.7% for vertical banded gastroplasty. Overall, all 3 procedures produced considerable weight loss in patients up to 4 years in the case of LAGB (the maximum follow-up available at the time of the review), and more than 10 years in the case of the comparator procedures.

Conclusion

The Australian Safety and Efficacy Register of New Interventional Procedures-Surgical Review Group concluded that the evidence base was of average quality up to 4 years for LAGB. Laparoscopic gastric banding is safer than vertical banded gastroplasty and Roux-en-Y gastric bypass, in terms of short-term mortality rates. LAGB is effective, at least up to 4 years, as are the comparator procedures. Up to 2 years, LAGB results in less weight loss than RYGB; from 2 to 4 years there is no significant difference between LAGB and Roux-en-Y gastric bypass, but the quality of data is only moderate. The long-term efficacy of laparoscopic adjustable gastric banding remains unproven, and evaluation by randomized controlled trials is recommended to define its merits relative to the comparator procedures.

Source:
Chapman AE, Kiroff G, Game P, Foster B, O'Brien P, Ham J, Maddern GJ. Royal Australasian College of Surgeons, Geelong Hospital, Australia.
National Library of Medicine 2004

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Laparoscopic or open bariatric surgery, such as gastric banding or bypass is not an easy solution to morbid obesity and weight loss. It is a serious surgical procedure, involving health risks. To produce lasting weight loss it requires a long-term patient commitment to eating a healthy diet and following a regular program of physical exercise. Life-long use of nutritional supplements may also be necessary. So, before deciding, discuss your options fully with your doctor. © 2003-2017 Bariatric-Surgery.Info - Terms - Contact - Information - Resources